Expert Roundtable Discussion on trauma featuring:
- Abe Antine, MSW, LCSW – Clinical Director
- Maria Talamo, MA, RN, NEA-BC, EDAC, FACHE – Chief Operations Officer
- Ryan Drzewiecki, PsyD, LP – Director of Psychology, Clinical Documentation, and Informatics
- Ryan Soave – Associate Clinical Director & Program Director of APN Coaching
From Florida to Colorado
Ryan Soave: You know, last week, we had the Rise program. I’m really fortunate to be able to come in from Florida and work here for a period of time and get connected with the team that’s here. This week, I’m back out here and working with the men in the trauma program and seeing everybody here. I think it’s been really amazing to see that this team has been assembled from really around the country. People are able to give input and participate in different ways, and I really feel welcomed when I come out here. It’s nice to be connected remotely, but it’s also great to show up here.
I never thought when I went back to school to become a therapist that I’d be able to be on the beach one day with my family and here in the mountains, maybe skiing, this week. I’m checking in with you guys and checking in with some folks who are out here in the beautiful mountains to heal. I’ve actually felt pretty welcome in town as I’ve met people. You know, it’s just really great to be a part of this team. I’m excited to see what we can accomplish. It’s definitely a big project.
A Treatment Dream Coming True
While there’s probably not any modalities we’ve created that are new, I’ve never seen a container like this, employing all of these modalities, anywhere in the world. We’re allowing people (and their families) to enter levels of care at different points in this container of the Lodge and the mountains. We’re looking out at them now, and I just feel like they’re just kind of hugging us. You know? It’s also great to see people who have experience in this field, all of us at the same time, stepping into something new – that nobody in the industry has experience with. It’s kind of exciting. We’re like explorers.
Maria Talamo: We are. It’s exciting to be part of a big dream. This is a very, very big dream – to provide world-class care in a five-star amenity experience.
Our founder, Noah Nordheimer, wanted to bring the best of clinical care and the best of what we know about the mind to a setting where you had a five-star amenity experience. He wanted to create a treatment setting where surroundings were beautiful, the lodge was beautifully appointed and decorated, with full spa services and athletic training, pools and hot tubs and access to many wellness activities and adventure experiences, and access to some of the best clinicians in the country. We’re recruiting hard for some of the best clinicians in the country to join our team. Already, we have quite a few really, really excellent clinicians.
Eagle County Needs More Mental Health Treatment
I’ve been integrating into the Vail Valley, coming from Texas. My experience has been that everyone that I’ve met so far is really excited about what we’re doing. We have many allies here in the Vail Valley, and I was pleasantly surprised to see that. The area is breathtakingly beautiful; these mountains are amazing. It is so beautiful out here, but it can be just . . . you know. The economy of the area and the way things change with the seasons in terms of employment can create situations where people find themselves struggling with existential questions.
Eagle County has a high suicide rate. Because this is a resort area, many people find themselves in situations where they’re getting in trouble with drugs, alcohol, and other substances.
There is a deep hunger for an excellent treatment resource in this Valley. I hear that over and over and over again. When I introduce myself to the folks in the ski shop who are fitting me for my boots, helping me pick out skis, or helping me with warm clothing (I come from Texas so I had to buy warm clothing to get out here because I didn’t have much of that back home), they’re very, very helpful. When I tell them what I’m doing out here, they immediately open up. Immediately open up. They begin to share either their personal journey in recovery or that of a loved one – a parent, a brother or sister, a close personal friend.
Community Support for a Community Investment
Then they usually say, “We’re really rooting for you. We’re so glad you’re coming to this area and making this investment in our community because we really need these services here.” So my experience is that everybody has been very welcoming so far. We have a lot of allies who are rooting for us and who have a story to share. Mental illness and the disease of addiction touch us all in some way, shape, or form – either personally or for someone we know and love and care about like a friend or family member.
There’s a close-knit faith-based community out here where people collaborate around issues that are important. For example, there was an interfaith service at Vail Chapel recently, and it was all about standing up to hate – that hate has no home here. It’s just a beautiful thing to see so many people come together from lots of different faith traditions, in solidarity, helping and supporting each other.
There’s a vibrant Chamber of Commerce out here, the Vail Valley Partnership, and we’ll be attending a big gala they host for which they raise money for the arts and education and cultural events. So there’s a tight-knit community that loves this Valley and wants to see it succeed and prosper. I’m enjoying getting to know people and hoping to become part of that effort to help continue developing this community.
Big Plans in a Small Town
Ryan Soave: I need to follow you around. You went deep. I was going to say skiing and the restaurants.
Ryan Drzewiecki: I was surprised by what a small town vibe there is here. I had no idea. I can’t go to the grocery store without running into five people I know, and I’ve only lived here for four months. It’s been great – not just the winter stuff either. We came at the end of the summer, and there was the summer concert series and wonderful hiking. There are so many great things to do. It’s been a really great move.
Abe Antine: For me, I have a funny story. My wife and I actually honeymooned in Vail eight years ago. And we had this five year plan to come out west. Then you know, life happens. We had a child, I started Next Chapter, and we kind of forgot about it. Then when I met Noah and we merged and came out here, this dream my wife and I had kind of put into the universe came true. I mean, this is a place that my wife and I have wanted to live for a long time. We weren’t the biggest fans of south Florida. We definitely are mountain people. We like to ski and hike. As Ryan said, the restaurants out here are amazing. It’s a very exciting lifestyle.
But yes, some of the things that you touched on, Maria, some of the mental health issues like suicide rates, some of that is really scary. I have some ideas that I’ve been thinking through around that – around what is driving some of that. But yeah, we love it out here. We really do. It’s amazing.
APN Lodge Coming Alongside Community Efforts
Maria Talamo: Yeah, we are committed to participating with community stakeholders to help improve mental health in the community.
We are joining the proud task force which is dedicated to trying to reduce opioid use disorder. They started out trying to do something in the community to deal with the opioid epidemic. Naturally, as more and more stakeholders from healthcare and addiction treatment and community mental health and law enforcement and the courts began to dialogue, they realized this is so much bigger than just opioid use disorder.
Now, the coalition has really expanded their focus even more broadly into mental health, which is a good thing. What I’ve learned from other communities, especially Austin TX, is that when you get stakeholders talking to each other on a regular basis, you can collaborate to make the entire system of care more recovery-oriented and get into more prevention activities.
Proactive with Prevention
We’re certainly going to be doing prevention activities. I think a really good example is the Athletics program where we are working with professional athletes in their sophomore year. This is a time when the wheels can come off – between the fame, the pressure to perform, the high salaries that elite athletes command, it can get people into trouble. Part of what’s going on with the Athletics program is the use of these prevention workshops for pro athletes entering their sophomore years to help them make good choices. Workshops for wives, like our NFL Wives workshop, are designed to help women help their husbands make really good decisions and stay true to their values.
Both of these workshops help direct players and their families to be really, really clear about what it is that they want in life and not get pulled into and distracted by situations that could lead to self-destruction.
So we’re about prevention as well as treatment. And we’re going to be about prevention as well as treatment here in the Vail Valley.
Vail Valley Warmth and Hospitality
Ryan Soave: You know, one of the things I’ve noticed coming out here is that the Vail Valley is a community based on hospitality. It’s people helping people to have a good time and be safe.
I’ve been fortunate to have a couple run-ins with ski patrol in the summertime while mountain biking. I have pictures of us being in these beautiful trees, and then the next picture is Abe with his shoulder broken. The EMT guys were amazing. They weren’t like, “You did something wrong.” They were really making sure that we were both safe and cared for.
Then it was my turn last week. I flipped over my skis as Abe was following me. Abe and I aren’t allowed to do any mountain sports together anymore. We need to have locals with us instead of just two Florida boys. I pulled a muscle in my leg, and the ski patrol really helped.
I’ve experienced a community that helps people have great experiences, helping people be safe and take risks.
I think that we’re a good fit for that too. That’s really what we’re doing at the core.
You know, behavioral health and mental health get a bad wrap. It seems like just this heavy and hard experience.
Mental Health Services Are Not Just for Rock Bottom
Really, it doesn’t have to be people hitting bottoms. We can just be working with folks to live life a little bit better – to be able to enjoy the things that are out here.
As an example, when I pulled my leg the other day, I was really mad and upset. I was projecting that I wasn’t going to be able to ski the next day. I work in this field, and I do a lot around mindfulness. Still, it was a lot of work for me to stay in the moment and remember, “You know, this is just a temporary experience.”
So I can see where there is a lot of opportunity to help folks with that sort of thing. We can do that with our workshops. It doesn’t just have to be people whose lives fall apart and need to come to the Lodge for 30 or 60 or 90 days. Sometimes, people just need a little bit of help getting to that next level, whatever that is for them.
Common Struggles of the Mountain Lifestyle
Abe Antine: It’s so interesting you bring that up – the injury that you’re talking about that happened to me in September. I had wanted to be out here for so long, and I love biking and climbing and skiing and all that other stuff. Then the first month I’m out here, I had this major injury. It took me away from all of the activities I had been anticipating.
That’s a very real struggle here, when people aren’t able to do the thing they came out here to do. We were talking about this yesterday. People start to age, and they can’t do the same things that they were doing before. All of that can lead to depression, anxiety, and some of the things that we’re talking about.
I really feel we can be such a great resource for the community on so many levels. Exactly, they don’t have to be hitting a rock bottom. But they can get to a place where this existential “Why am I here? I came here to do all this, and for some reason I can’t.”
A Vail Culture of Adventure and Risk
Ryan Soave: I went to the movie theater last night, and I was shocked to see how many sets of crutches there were in seats next to people. I live in South Florida. There are more walkers in seats. Here, people are on crutches and in slings and stuff like that. I was really quite shocked.
Abe Antine: Here, you’re walking around with a crutch or a sling, and people come over to you and start naming names. I didn’t know what they were doing. It turns out, they were naming the orthopedist who did the work. It’s like a badge of glory here. It’s your passage, almost.
From Health to Mental Health
Ryan Soave: When I went to the hospital with you, I was really impressed. It didn’t seem like I was going into a hospital. It seemed like I was going into a nice hotel. Everyone was really welcoming. You were in and out. Part of that is that it’s a small community, but it also shows that people here have an investment in health and fitness.
There are a lot of very fit people around here. It’s good to see that. I think one of the things that’s missing in our community, in our nation even, is that we have a lot of focus on physical health and physical fitness, but as soon as someone says “mental health,” they’re really talking about mental illness.
I think we can refocus to start talking about mental fitness. I don’t have to have a problem. I can just want to be able to look at things in a different way and be “fit.” People go to gyms and exercise; there are ways to do that for your mind. That can help us really, really be present with life, enjoy our families, and enjoy the stuff out here too.
Experiential Therapy to Treat the Body and Mind
Abe Antine: I don’t know if you guys knew we’ve been doing this, but we’ve been taking our current clients to the hill twice a week. We’ve been snowshoeing. We’re going to do a snowmobiling trip too. One of the things that was so attractive about merging Next Chapter with All Points North is the ability to do that kind of work and trauma work.
Addiction is all about regulation. It’s emotional regulation. Trauma is the problem, and addiction is the way we regulate that trauma.
So much of trauma is stored in the body, so being able to get clients outdoors and do things like skiing, hiking, and some of the other modalities that we incorporate like yoga and breathwork, and to do it in this setting, it’s kind of a dream. There’s no better way. Then along with the partnerships at Vail Health to check those boxes with the Executive Packages, it’s pretty much everything you can ask for in creating a place of healing.
Breathwork as Trauma Treatment
Ryan Soave: As you’re saying that, I think about when I’m looking at the view or staring out at the mountains and someone says, “That’s breathtaking.” There’s a reason that we’re saying that. It causes you to pause and breathe. You’re really being present with what’s there.
Exercise, hiking, snowshoeing – they cause you to breathe. A lot of the problems that we have around regulation of emotion is about our breath. I have a teacher that always says, “If you want to change your mind, change your breath.” We have breathing patterns for different states. If I’m really angry or if I’m really sad, chances are I’m not taking long, deep breaths. It’s what we work on in meditation, and being outdoors to walk, hike, or ski is really a meditation in motion. It brings us into that moment. We’re never actually living outside of this moment, but we get oriented to these other things.
For me, I know when I’m out in the middle of the wilderness, my phone’s not working, and I’m looking at what my step is, I feel very present. I’m very connected. I feel really safe actually, even sometimes in unsafe situations.
Abe Antine: Although, Vail has figured out a way for your phone to work pretty much anywhere you want on that mountain, so you’re never too far away.
Therapy in Mountain Motion
Ryan Drzewiecki: I think the icing on the cake too with some of these activities is the ability to send out an experiential therapist and have people process in the moment.
We can look at, “Are you able to be mindful right now? What are some of the blocks that are coming up? What is this experience like for you? How is it to be out here doing this? What does it bring up? Where do you see these issues elsewhere in life?” So everything becomes an opportunity for growth and learning and self-actualization.
Ryan Soave: Yeah, “Where does fear show up in your body? Where will you take risks? Where will you stop? Where are you able to move through things or not?” You can actually see people’s fight, flight, and freeze responses in athletic experiences, especially in ones that induce a little bit of fear, whether it’s on the mountain or on a ropes course or on a zipline. You can also observe some people who seem to be stuck emotionally or won’t take risks in relationships but then go all out in adrenaline-seeking behaviors and things like that. It’s really interesting to be able to see that.
“How You Do One Thing is How You Do Everything”
Abe Antine: That’s a great point that you bring up, and it reminds me of something else that I think is really unique about what we’re doing here.
Yes, we’re doing these adventure therapies – skiing, hiking, snowshoeing – but it’s being done with therapists. There’s an opportunity and therapeutic component that comes out in a lot of the things we’re talking about. So it’s not just having a good time, which is important, but it really is treatment. We want to see those experiences through a clinical lens.
It’s the same with this Lodge. I’ve been asked by colleagues, “Let me get this straight. You’re going to try to bring clinical excellence into a five-star amenity resort. How’s that going to work? Is it a resort, or is it treatment?” If our clinicians are trained in a way that they’re able to utilize these amenities through a clinical lens, they’re not fluff. It’s not just about massage treatments and a beautiful fitness center. It’s about using all of that clinically, which changes the whole dynamic of it.
Ryan Drzewiecki: When people look at things through the perspective that how you do one thing is how you do everything, then you pull out the patterns or roles or enactments you’re playing out right now that are actually reflective of the way you’re participating in life or interacting with other people. It’s about what we can do about that.
Finding the Optimal, Not the Extremes
Ryan Soave: Yeah, you know, there have been a couple of extremes I’ve seen in addiction treatment. One is stripping every single thing away from a person. This had been a common model for a period of time, and I’m sure it still exists. But it can be very much shame-inducing. The theory was that it “creates humility”, but this often doesn’t reflect the client’s real life.
Maybe you can function in the world that is a protected environment. But then you go back to your family, you go back into your workplace, and you’re not protected anymore. Now that inability to create “humility” can induce even more shame.
Then there’s the other side that’s existed in treatment for awhile where people are completely indulged. They’re given everything they could possibly want or need, and it’s not viewed through a clinical lens.
Here, we’re striving to meet people where they are and give them an experience where treatment doesn’t have to be about the reduction of everything in your life. Being sober doesn’t have to take everything away. It can be about building a life. We can do it in a setting that makes people comfortable, where we treat them with respect, dignity, and let it be nice for them.
Isolation Prevents Exposure
Abe Antine: A few weeks ago, we took our clients skiing. For lunch, we took them into the ski lodge. One of our clients said she’s been skiing since she was a kid but hasn’t been skiing without having alcohol in the ski lodge since she was 17 years old. She was incredibly triggered.
This experience was an opportunity for the staff member that was with her to go on a walk and process with her.
I mean, that’s treatment.
Going away somewhere for 28 days, in some secluded place where you’re just there without any kind of exposure to any of this, that’s not real life. It’s almost a disservice. I feel that experiences like taking them to places where they’re around alcohol, where they’re exposed to some of their triggers, is the way to really help them. When they leave here, like you said, the real world shows up. She’s going to go skiing and hit that lodge, and she would have never had that experience of being there and not drinking. Now she has.
Purposeful Freedom, Purposeful Restriction
Ryan Soave: Yeah, and I’ll talk about some of the freedoms we’re giving them in the Lodge. To be honest, I had to wrap my head around this in a new way because it challenges some of the norms.
People are going to have access to their phones or access to computers, but it’s not going to be unregulated. If they’re abusing this or if they’re coming from a situation where technology was something that was a problem, we’re going to look at it a different way. If it’s somebody who does not have an issue with that or that needs to work through some issues around how they contact their family or how they contact their work, Abe has always said that treatment doesn’t really start until the crisis occurs.
There needs to be some sort of energy in the tank. It’s not enough to just be away from everything and in a bubble.
Sometimes people need to be for a little bit before they can start stepping into some of these freedoms though, and we’ll be able to accomplish that with folks too. Some need to be a little bit more contained because they’re able to take on more freedoms in a healthy way. We’re going to be able to assess each individual and see where they are. It’s not a one-size-fits-all program.
Embracing Health Through the Best Balance Possible
Maria Talamo: It’s about embracing health, making healthy choices, and learning how to make those healthy choices. For a lot of folks, this involves developing skills they had never developed before and then exercising them.
As Abe says, being exposed to those triggers again and learning how to make that healthy choice.
So good nutrition is part of it. We’re going to be scratch cooking everything. We’ve hired a wonderful executive chef, Ronnie Sanchez, who has tremendous experience in the hospitality industry and who is very much dedicated to whole food, fresh food cooking.
We consider everything from really good sleep to excellent nutrition to body work (yoga, tai chi, movement therapy, weight lifting, access to personal trainers, swimming, skiing, outdoor adventure activities). It’s an opportunity to embrace health, building healthy habits that affirm your love for yourself.
It’s about learning to love yourself enough to take good care of your body and mind. You have access to everything you need here to do that. Then, it’s about learning how to build all that into your own life. How do you build it into your own life so that you are set up to make healthy choices and take good care of yourself after you leave us?
Ryan Soave: Yeah, with balance. You know? It’s really about the need to seek balance.